Week 1: PMH Flashcards
What is it?
a woman’s mental health during pregnancy and the first year after birth. Includes mental illness existing before pregnancy, illnesses that develop for the first time, or are greatly exacerbated in the perinatal period
What factors should you consider when assessing a woman’s mental health from a holistic care approach?
History of any mental health problem, including in pregnancy or the postnatal period Physical wellbeing (including weight, smoking, nutrition and activity level) and history of any physical health problem Alcohol and drug misuse (40-60% co-morbidity with psychiatric illness) The woman’s attitude towards the pregnancy, including denial of pregnancy (concealed pregnancies, rape or abuse) The woman’s experience of pregnancy and any problems experienced by her, the fetus or the baby The mother–baby relationship - consider role models Any past or present treatment for a mental health problem, and response to any treatment – details help, situational Social networks and quality of interpersonal relationships Living conditions and social isolation Family history (first degree relative) of mental health problems Domestic violence and abuse, sexual abuse, trauma or childhood maltreatment – Complex PTSD Housing, employment, economic and immigration status Responsibilities as a carer for other children and young people or other adults.
Why do maternal deaths happen?
Most occur within 3 months before and after birth Poor identification of past history Poor training Poor understanding of risk and poor management of risk Poor communication by psychiatric services, maternity services and primary care No specialised perinatal mental health services Neglect of physical health in women with mental health problems
What are some common mental health disorders?
Depression and Anxiety OCD Phobias (agoraphobia) Panic Attacks – Generalised Anxiety Disorder Personality Disorders – EUPD/BPD PTSD and Complex PTSD Eating Disorders and Body Dysmorphic Disorder (BDD) Bipolar Type 1 and Type 2 Schizophrenia or Schizoaffective Disorder
How can we recognise depression, anxiety, OCD and bipolar mania?
What is the idea behind fetal programming?
“Environment in the womb during different sensitive periods for specific outcomes, can alter the development of the fetus, with a long lasting effect on the child” Sensitive early mothering helps attachment, and can counteract some of what happens in the womb
What types of antenatal stress are associated with changes in the development and behaviour of a fetus?
Maternal anxiety and depression Maternal daily hassles Pregnancy specific anxiety Partner or family problems Wars Experience of acute disasters i.e. 9/11, Terrorist Attacks, Tsunamis Maternal history of sexual abuse predicts elevated anxiety/depression in pregnancy – this is significantly stronger for women who knew the perpetrator Its not just extreme or toxic stress or diagnosed mental illness
Antenatal stress increases the risk of the fetus developing…?
Anxiety and Depression Behavioural Problems – ADHD Impaired cognitive development Sleep problems Difficult infant temperament Victimisation in childhood Schizophrenia and Autism Reduced birth weight and prematurity Asthma and altered immune function Maternal stress/Anxiety/Mental Illness - trans placental passage cortisol into baby
Drug X
- Passes freely cross the placenta and into breast milk
- Doses of >300mg per day decrease the chances of conception
- Negative effects on sperm motility
- Increased risk of miscarriage with doses >300mg/day
- Associated with teratogenesis and low fetal weight
- Studies in rodents have found an increase in the rate of malformations, specifically cleft palate
- Children born to mothers who consumed >500mg/day were more likely to have faster heart rates, tremors, increased respiration rates and spend more time awake after birth
- High doses in pregnancy associated with subsequent SIDS
What should conversations on medication cover?
Antidepressants?
What does evidence suggest about the use of antipsychotics in pregnancy?
What advice should be given in the use of antipsychotics?
